title: Extracortical plate fixation with new plate inserts and cerclage wires for the treatment of periprosthetic hip fractures.
abstract: OBJECTIVE
  Fixation of periprosthetic hip fractures with intracortical anchorage might not be feasible in cases with bulky implants and/or poor bone stock.
  
  
  METHODS
  Rotational stability of new plate inserts with extracortical anchorage for cerclage fixation was measured and compared to the stability found using a standard technique in a biomechanical setup using a torsion testing machine. In a synthetic PUR bone model, transverse fractures were fixed distally using screws and proximally by wire cerclages attached to the plates using "new" (extracortical anchorage) or "standard" (intracortical anchorage) plate inserts. Time to fracture consolidation and complications were assessed in a consecutive series of 18 patients (18 female; mean age 81 years, range 55-92) with periprosthetic hip fractures (ten type B1, eight type C-Vancouver) treated with the new device between July 2003 and July 2010.
  
  
  RESULTS
  The "new" device showed a higher rotational stability than the "standard" technique (p < 0.001). Fractures showed radiographic consolidation after 14 ± 5 weeks (mean ± SD) postoperatively in patients. Revision surgery was necessary in four patients, unrelated to the new technique.
  
  
  CONCLUSIONS
  In periprosthetic hip fractures in which fixation with intracortical anchorage using conventional means might be difficult due to bulky revision stems and/or poor bone stock, the new device may be an addition to the range of existing implants.
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Inselspital, University of Bern, Freiburgstrasse 3, 3010, Bern, Switzerland, johannes.bastian@insel.ch.
authors.forename: Johannes D
authors.initials: JD
authors.lastname: Bastian
authors.forename: Andre
authors.initials: A
authors.lastname: Butscher
authors.forename: Gianni
authors.initials: G
authors.lastname: Bigolin
authors.forename: Matthias A
authors.initials: MA
authors.lastname: Zumstein
authors.forename: Hubert P
authors.initials: HP
authors.lastname: Nötzli
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation*; D001696:Biomechanical Phenomena / Q000502:physiology; D001860:Bone Plates; D001864:Bone Wires; D004867:Equipment Design; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D006620:Hip Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000502:physiology / Q000601:surgery; D006622:Hip Prosthesis; D006801:Humans; D008875:Middle Aged; D057068:Periprosthetic Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D019415:Torque; D016896:Treatment Outcome